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991.
992.
993.
A 40-year-old woman presented with progressive lower leg pain and spontaneous toe movement. The EMG showed a posterior tibial nerve mononeuropathy and continuous myokymic discharges in posterior tibial-innervated muscles. The MRI revealed a markedly enlarged posterior tibial nerve. Toe movements and myokymia were unaffected by the proximal transection of the lesion but ceased abruptly when the distal end of the fusiform "tumor" was resected, suggesting that spontaneous electrical foci may have been located along the nerve lesion. The markedly enlarged nerve segment contained edematous, swollen fascicles with marked Schwann cell onion-bulb lesions and angiocentric, lymphocytic, and lymphofollicular infiltration. This nerve lesion is an example of a newly recognized entity called hypertrophic mononeuritis. 相似文献
994.
Frank E. Block Jr. 《Journal of clinical monitoring and computing》1990,7(2):141-145
With the advent of automated anesthesia record keeping devices, concern has arisen that abnormal values will appear in the record and possibly lead to medicolegal compromise. A retrospective review of automated records from a series of anesthesia cases was undertaken to determine if abnormal values do occur, how frequent they are, and whether they cause problems. A total of 14,826 (4,942 each) noninvasive heart rate, systolic, and diastolic blood pressure readings from 118 case printouts generated by a Diatek Arkive Patient Information Management System (63 cases) or a Data-scope Datatrac record keeper (55 cases) were recorded. The study sample covered a broad range of surgical operations, anesthetic procedures, and patient ages and medical histories. During these 118 anesthetics, the majority of readings of all three variables fell within normal ranges (defined for this study as 80 to 180 and 50 to 110 mm Hg for systolic and diastolic blood pressures, respectively, and 60 to 140 beats/min for heart rate). During the anesthetics, 3.6% of the systolic pressure readings, 13.25% of the diastolic readings, and 4.25% of the heart rate readings were recorded outside these ranges. No serious intraoperative or postoperative anesthesia complications were associated with these out-of-range readings, nor would they be expected in a sample of this size, since serious anesthetic complications are rare. This preliminary observation of one person's experience may help address the concern associated with allowing high and low blood pressure and heart rate readings to be automatically recorded unsmoothed. In medicolegal situations, it should also begin to demonstrate that such fluctuations are neither uncommon nor abnormal, and that a true record of these readings should be neither a cause for concern nor an opportunity for medicolegal exploitation. 相似文献
995.
996.
S M Rahman B T McKibben T G Hardy C D Schloss C C Cho R F Hartmann P S Aguilar K S Khanduja W R Stewart 《Southern medical journal》1990,83(7):774-777
From January 1979 to October 1986, 86 patients with surgically resectable adenocarcinoma of the rectum or rectosigmoid were treated with adjuvant radiotherapy consisting of preoperative 2,400 cGy (22 patients), preoperative 4,000 cGy (14 patients), "sandwich" technique (27 patients), and postoperative irradiation (23 patients). Average follow-up was 42.9 months. The local recurrence rate was 4.5%, 9.1%, 7.4%, and 34.8%, respectively. The distant metastasis rate was 18.2%, 18.2%, 7.4%, and 30.4%, respectively. Preoperative radiotherapy with adequate surgical resection appears more effective in reducing the incidence of local recurrence. 相似文献
997.
With the recent innovations in cardiac surgical techniques, there is need for an immediate and reliable way to assess results in the operating room. Intraoperative epicardial echocardiography with Doppler color flow mapping provides an accurate and rapid imaging modality to assess the anatomical and functional results of cardiac surgery. This gives the surgeon a way to determine whether the hemodynamic abnormality has been successfully eliminated, prior to closure of the chest. After enclosure in a sterile sheath, a standard echocardiographic transducer is placed directly onto the epicardial surface. The heart is imaged in multiple tomographic planes developed specifically for intraoperative use: the parasternal equivalent; aortopulmonary sulcus; subcostal equivalent; and aorta-superior vena cava transducer positions. Two-dimensional echocardiography is useful to assess the morphology of valves and the size and function of cardiac chambers. Doppler color flow mapping provides a semi-quantitative assessment of the severity and physiological mechanism of valvular regurgitation. Continuous-wave Doppler echocardiography is used to estimate gradients across stenotic valves. This comprehensive appraisal of cardiac anatomy and flow is useful in the pre- or postcardiopulmonary bypass phase of cardiac surgery. This review focuses on the technique of intraoperative echocardiography and its applications in valve reconstruction operations with specific emphasis on the epicardial imaging planes. 相似文献
998.
A questionnaire was administered to the nursing staff of a large teaching hospital to determine: 1) sources of stress in caring for AIDS patients; 2) perceived sources of stress in being an AIDS patient; and 3) attitudes towards "deserving" various illnesses. Principal components analyses revealed a number of factors related to increased stress, including: general concerns about the care of these patients; specific concerns in crises situations; and concerns regarding the personal/social implications of caring for these individuals. These factors were not related to either prior experience taking care of AIDS patients, or nursing specialty. In addition, persons with AIDS were viewed as "deserving" their illness in much the same way as noncompliant diabetic or renal patients. Potential implications of these findings and suggestions for future research directed towards mitigating these occupational stressors are given. 相似文献
999.
The development of a DCP in the manner presented previously has allowed for a consistent definition of customer needs and expectations within a pharmacy service. By applying this approach it has allowed the department to address the controversies associated with the identification of key customers and has also allowed a balance to be achieved between internal and external forces. From our analysis it is clear that the pharmacy department has a critical role in establishing a customer service philosophy that is key to the overall success of the institution's quality goal. It is also clear that pharmacy services cannot truly be developed without a customer service philosophy central to their design and implementation. In an era where drug expenditures represent an ever-increasing portion of corporate budgets, the pharmacy's ability to deliver goods and services that are customer and quality focused will be critical to organizational survival. The time has come to put ego aside and critically analyze whether or not a quality service is being delivered that meets a true customer need. 相似文献
1000.
Waggoner DM 《Topics in health information management》1993,14(2):22-31
Data-driven process improvement, such as that at Harper Hospital described earlier, requires several critical elements. First, data must be readily available, accurate, timely, and easy to analyze. Over 200 charts and graphs were produced at Harper Hospital to support the work of the five teams. Often, teams met weekly and data had to be accessed, analyzed, and turned around in five working days. Without the right systems, this is impossible. Second, accuracy of data and accessibility are issues. Sometimes, data are not accessible because of disparate systems or databases, or because they are not collected in a format to support analysis. An example of the latter occurred at Harper Hospital when it was discovered that surgical OR supplies were billed at one inclusive rate and that the detail data were not collected in an automated system. Manual analysis could not be done in the time frame required and momentum was lost. Next, timeliness is an issue when physicians are asked to make decisions using dated data. For most purposes, data should be no more than three months old. Ideally, two weeks should be the limit. Some hospitals are making new data available hourly. Trends change too rapidly, lengths of stay shorten, new antibiotics are introduced, new treatments are available, and reimbursement changes too often to use old data for decision making. Lastly, tools should be readily available to bring the story from the numbers. Graphs, charts, and statistics need to be used much more often and in more imaginative ways. As the health care information industry makes databases more user-friendly, physicians will understand and regain their potential to use medical science to improve the lives of their patients. 相似文献